Scintigraphy guided stereotaxic localizations apparatus for breast carcinomas

ABSTRACT

A scintigraphy guided system for stereotaxic localization of breast carcinomas, used in conjunction with a scintillation detection device, of a patient who has been injected with a radioactive substance which preferentially accumulates in carcinomas. The system includes a table, a pair of fenestrated paddles, and a guide means. The table has a top surface, upon which the patient lies in a prone position, and at least one opening through which the patient&#39;s breast being examined will pendulously protrude therethrough. A pair of fenestrated paddles are positioned under the bottom surface of the table in the vicinity of the opening, and are moveable relative to each other to compress the patient&#39;s breast therebetween. The guide is positioned under the table in the vicinity of the opening. The guide has plurality of moveable sighting guides, each moveable along one of three orthogonal axes, and each sighting guide having a radioactive sighting line located thereon. The moveable sighting guides are moved to line up with the lesion site, as detected by the scintillation detector device, to localize the lesion in three dimensions and in real-time.

BACKGROUND OF THE INVENTION

1. Field of the Art

This invention relates to the field of breast lesion localization andbiopsy, and more particularly to an apparatus for localizing a breastlesion by scintigraphy in three dimensions and in real-time.

2. Description of the Prior Art

The occurrence of breast cancer is a leading cause of death for women.Women are advised to conduct breast self examination for palapable lumpsor bumps on a monthly basis, and after the age of 40, to undergomammography at least on a bi-annual basis in order to detectnonpalapable lesions. Presently, special roentgenography, or x-raytechniques for photographically studying the mammary gland, or breast,are utilized to locate lesion with greater success than withself-examination, particularly with small lesion located deep in thebreast. However, one major problem with traditional x-ray mammography isthat there is little selectivity in what is imaged. In addition tomalignant carcinoma tumors, generally harmless calcifications,proliferative changes, fibroadenomas, and fibrocystic changes show up.Indeed, while x-ray mammography has a high sensitivity of 85-90%, itcurrently predicts malignancy in only about 20-30% of mammographysuspicious lesions. Since the radiologist has great difficulty indistinguishing malignancy from harmless lesions, biopsy and tissuecultures must be carried out to determine if the lesion is malignant. Infact, in around 80% of the cases where biopsies are performed, thelesions prove not to be malignant.

In order to effectively conduct the x-ray mammography, the patient'sbreast being imaged must be compressed with great and uncomfortableforce to squeeze the breast to a thickness of about three to four and ahalf centimeters so that the x-rays can adequately penetrate the breastand develop the film lying behind the breast. This process must beconducted in two separate planes. First, the breast is compressed in ahorizontal plane, so a cranial and caudal projection can be taken. Thenext projection taken is a mediolateral oblique view, wherein the breastis compressed in a vertical plane. These two initial views takentogether make up the screening mammography.

The radiologist will then read the x-ray negatives to determine if thereare any lesions or other signs of lesions in the breast. If theradiologist sees any suspicious lesions, then "special views" are taken.Actually, the same views as in a screening are carried out, except thatthe compressed breast is slightly displaced from the film plate toeffect magnification of any lesions in the breast. If the radiologistfinds a suspicious lesion, a biopsy needle will be inserted into thelesion site of the anesthetized breast.

After the needle is placed in the breast, another x-ray image will betaken, to determine how close the tip of the needle is to the lesion.Several adjustments of the needle and several x-ray photographs may berequired to position the needle at the lesion site. Once the biopsyneedle is positioned near the lesion site, a hooked guide wire will bepushed through the biopsy needle and hooked onto the lesion. The guidewire provides the surgeon with a traceable path to the lesion. Thesurgeon will then remove either a sample of the lesion (i.e. byaspiration biopsy), or the entire lesion in surgical biopsy procedure,and the tissue removed will be examined by the oncologist. This processis time consuming, painful, physically scaring, and expensive. Thepatient will then wait a few agonizing days to learn of the testresults. Again, since by x-ray mammography the radiologist cannotreadily distinguish between malignant and non-malignant lesions, whensuspicious lesions are located, biopsy are required. Since statistically80% of all lesions are non-malignant, present x-ray mammographytechnique results in many unnecessary biopsies.

Several approaches have been explored to better locate the position ofthe lesion in a patient's breast by x-ray mammography. U.S. Pat. No.5,209,232 to Levene uses computerized device to accurately detect theposition of lesions in the breast, and to position the biopsy needle.U.S. Pat. No. 5,289,520 to Pellegrino et al. and U.S. Pat. No. 5,078,192to Siczek et al. provide automated breast lesion locator imaging andbiopsy systems.

U.S. Pat. No. 5,056,523 to Hotchikiss, Jr. et al. discloses a device andmethod for precisely positioning the tip of a probe into a breastlesion. Radiopaque markers are used to identify the position of thelesion relative to a fenestrate compression grid. To determine the depthof the lesion in the breast, a certain amount of trial and error isrequired. A similar system is provided by the method and apparatus ofU.S. Pat. No. 4,875,478 to Chen. The Chen apparatus used a radiolucentcompression support plate with calibration marks, with a movable biopsyneedle support guide, so that the biopsy needle can be positioned withits tip in the lesion. Notwithstanding the improvements provided bythese x-ray mammography devices, major problems remain in that manyunnecessary biopsies will still be to be performed.

Another new, experimental method utilizes contrast material-enhancedmagnetic resonance (MR) mammography, and is disclosed in "MRMammographic Localization, Work in Progress", by K. Hussman et al.Radiology, Vol. 189, No. 3, pp. 915-917. By this method, after MRresonance enhancing agents are injected into the patient's bloodstream,her breast being examined is placed in an open box with two fenestratedperpendicular side walls. The position of the lesion in the X, Y and Zcoordinates is noted, and the precise position of the biopsy needle willthen be sought to be located. Since the magnetic resonance apparatus isquite narrow to enter, the needle must be inserted after the patient'sbreast is imaged. To avoid the breast shifting in the box, the breast isbest temporary adhered to the box with medical grade adhesive. Thetechnique of the Hussman et al. device, is highly uncomfortable,cumbersome, and expensive, and makes this approach disfavored.

Recently, the use of Technetium-99m Sestamibi (sold under the nameCardiolite®, by the DuPont Merck Pharmaceutical Co., Billerica, Mass.)has been explored to accurately detect the presence of carcinoma of thebreast. See "Review of Imaging Techniques for the Diagnosis of BreastCancer, a New Role of Prone Scintimammography using Technetium-99mSestamibi", by I. Khalkhali, I. Mena, and L. Diggles, European Journalof Nuclear Medicine, Vol. 21, No. 4, April 1994, pp. 357-362, and "ProneScintimammography in Patients with Suspicion of Carcinoma of theBreast", by I. Khalkhali, I. Mena, E. Jouanne, L. Diggles, R. Venegas,J. Block, K. Alle, and S. Klein, Journal of American College ofSurgeons, May 1994, Vol. 178, pp.491-97.

Scintimammography is the method to detect the presence of malignanttumors by radioactive substances which selectively accumulate in themalignant tumors, or carcinomas.

By utilizing the method of scintimammography with Technetium-99mSestamibi, the inventors have reported a negative predictive value forthe presence of carcinoma of 97.5%, a sensitivity of 96%, and aspecificity of 85%. More importantly, by the method of scintimammographyusing Technetium-99m Sestamibi, malignant lesions as small as 2˜3 mm orsmaller can be diagnosed.

However, there has not been as of yet a method and apparatus foraccurately localizing carcinomas of the breast by real-timescintimammography. There accordingly remains a need for a scintigraphyguided stereotaxic localization apparatus and method for carcinomas ofthe breast.

SUMMARY OF THE INVENTION

A first objective of the invention is to provide a scintigraphy guidedsystem for stereotaxic localization of breast carcinomas, used inconjunction with a scintillation detection device, of a patient who hasbeen injected with a radioactive substance which preferentiallyaccumulates in carcinomas, said system comprising:

a table means, with a top and bottom surface, upon which the patientlies in a prone position, and at least one opening through which thepatient's breast being examined will pendulously protrude therethrough;

a pair of fenestrated paddles positioned under the bottom surface of thetable means in the vicinity of the opening, said pair of fenestratedpaddles being moveable relative to each other to compress the patient'sbreast therebetween; and

a guide means positioned under the table means in the vicinity of theopening, said rack means having a plurality of moveable sighting guides,each moveable along one of three orthogonal axes, each sighting guidehaving a radioactive sighting line located thereon, wherein saidmoveable sighting guides will be moved to line up with the lesion site,as detected by the scintillation detection device, to localize thelesion site in three dimensions and in real-time.

Another objective of the invention is to provide a scintigraphy guidedsystem for stereotaxic localization of breast carcinomas, used inconjunction with a scintillation detection device, of a patient who hasbeen injected with a radioactive substance which preferentiallyaccumulates in carcinomas, said system comprising:

a table means, with a top and bottom surface, upon which the patientlies in a prone position, and at least one opening through which thepatient's breast being examined will pendulously protrude therethrough;

a pair of fenestrated paddles positioned under the bottom surface of thetable means in the vicinity of the opening, said pair of fenestratedpaddles being moveable relative to each other to compress the patient'sbreast therebetween; and

a guide means positioned under the table means in the vicinity of theopening, said rack means having a plurality of moveable sighting guides,each moveable along one of three orthogonal axes, each sighting guidehaving a radioactive sighting line located thereon;

wherein in the use of the system, the patient's breast will becompressed by the fenestrated paddles, and the scintillation device willbe placed adjacent and generally parallel to a first plane defined bytwo of said three orthogonal axes along which two sighting guides aremoveable, to detect radioactive photons given off by the radioactivesubstance accumulated off the carcinoma site, and said two sightingguides will be moved so their sighting lines project over the center ofthe carcinoma site, thus localizing the carcinoma site intwo-dimensions, and the scintillation detector will be placed parallelto a second plane, orthogonal to said first plane, and in front of thethird sighting guide, and a third sighting guide will be moved along thethird orthogonal axis, until its sighting line is in line with thecenter of the carcinoma site, whereby said three sighting lines willthus positively localize the carcinoma site in real-time and inthree-dimensions relative to the fenestrated paddles.

While the method of scintimammography has been known, before thisinvention, there has not been any apparatus and method to localize thecarcinoma for biopsy and/or removal, in real-time.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective partially exposed view of the apparatus of theinvention, and a scintillation detector.

FIG. 2 is a perspective view of a fenestrated paddle of the system.

FIG. 3 is a partial side view of the system showing a patient's breastbeing compressed between the fenestrated paddles, less the slidingguides, with needle guide and a syringe.

FIG. 4 is a bottom-up view of the system, showing a patient's breastbeing compressed, one sighting guide, and the scintillation detector.

FIG. 5 is a partial side view of the system, showing two sliding guideslined up with a carcinoma site.

FIG. 6 is a distribution of breast tumors localizations in a phantombreast.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to FIGS. 1 and 2-5 there is illustrated a scintigraphy guidedstereotaxic localization apparatus 10 for breast carcinomas. Theapparatus 10 has a generally horizontal table portion 12 with an uppersurface 14 upon which a patient lies, and a lower, underside surface 16.Openings or cut-outs 18 are formed on opposite side regions 20 of thetable portion 12. The openings 18 are separated by an intermediate tableportion 22 sufficiently wide such that when the patient lies prone onthe table portion 12, the breast not being examined will be supported onthe intermediate table portion 22.

A pair of fenestrated paddles 24 are positioned under the table 12, andslide in slider guides 26 mounted to the underside 16 of the table 12.

Best referring to FIG. 2, each fenestrated paddle 24 has a planar,breast compression portion 28 with a large number of holes 30 formedtherethrough. These holes 30 are formed evenly spaced in the breastcompression portion 28 in preferably a uniform grid pattern. Extendinggenerally perpendicular from the planar compression portion 28 is aslider bar portion 32. The holes 30 can be placed as close as one to twomillimeters apart, and are sized to receive a optional needle guide 34.The needle guide 34 has an insertion portion which fits into a hole 30,and an elongate body. The needle guide 34 has a coaxial hole (not shown)which is sized to fit a needle 42, and the needle guide thus serves toguide the needle into the breast at right angles to the breastcompression portion 28 of the fenestrated paddle 24. The apparatus 10 isdesigned to accommodate both 23 gauge and 16 gauge needles 42,permitting fine needle aspiration and core biopsies, respectively, to beperformed. Other gauge needles can also be utilized. Where core biopsiesare taken, the core biopsy guide wire 42 will preferably have aCobalt-57 tip protected by Teflon® (to prevent any possibility ofCobalt-57 being left in the patient's breast).

The fenestrated paddle 24 is best formed of radioactive non-attenuatingmaterial, so as not to absorb the radioactive photons given off from theradioactive material (viz. Technetium-99m Sestamibi). The inventors havefound plastics such Plexiglas®, and particularly Lexan® to be goodmaterials for the construction of the compression paddles 24, withLexan® being a preferred choice because of its great durability.Preferably, in order to avoid cross-contamination between patients, thecompression paddles 24 and needle guide 34 are designed for single use,and should be disposed of after use. The close spacing of the holes 30in the compression portion 28 permits the accurate biopsy of extremelysmall lesions.

Referring to FIGS. 3 and 4, the slider bar portions 32 of thecompression paddles 24 slide in the slides guide 26. A means is providedto immobilize the two paddles 24 relative to the breast compressedtherebetween. This can, for example, comprise a thumbscrew 44 threadedthrough a bore in the slider guide 26, whose end frictionally engageswith the slides bar portion 32, to thereby immobilize it in a desiredposition. If desired, one fenestrated paddle 24 can be made to bestationary (not shown).

Unlike the methods of x-ray mammography, in scintimammography, thebreast need not be compressed tightly to a great degree. Rather, thedegree of compression required is that which is enough to flatten thebreast against the fenestrated paddles 24, as is best shown in FIGS.3-5.

Referring to FIGS. 1, 4, and 5 a positioning guide means or rack means46 is mounted to the underside 16 of the table portion in the vicinityof the openings 18. The rack means 46 has a horizontal track portion 48which lies horizontally, along an "X" axis, and a vertical track portion50, which lies vertically, along a "Y" axis. Referring to FIG. 4, therack means also has track portions 52 which lies along a "Z" axis. Thetrack portions 48 and 50 provide tracks, upon which moveable sightingguides 54 and 56, respectively, slide.

The sighting guides 54 and 56 have track engagement sliders 58, whichslidable engage with the track portions 48 and 50. Materials such asNylon® and Teflon® plastic work well, as they can be made to smoothlyslide on the track portions 48 and 50. Materials such as aluminum alloycan be used to form the track portions 48, 50 and 52. Extendingoutwardly at a right angles from the track engagement slides areelongate carrier portions 60, formed of non-attenuating material such asPlexiglass®, Lexan®, and other plastic materials. The carrier portions60 each carry a radioactive sighting line 62 and 64, respectively. Theinventors use a Cobalt-57 containing wire. The sighting line 62 of thesighting guide 54 lies along a "Y" axis and the sighting line 64 ofsighting guide 56 lies on an "X" axis. The sighting guides 54 and 56 canbe moved, until their sighting lies 62 and 64 line up with the "X" and"Y" coordinates of the carcinoma site "C", as will be described ingreater detail further below.

Referring to FIG. 4, the rail portions 52 which lie in a plane parallelto the underside 16 of the table portion lie on "Z" axes and carry amoveable sighting guide 66, which spans the two rail portions 52, and isslidable thereon. The horizontal sighting guide 66 has slider guides 68which actually slide on the rail portion 66, support arms 69 whichextend therefrom, and a carrier portion 70. As with the other moveablesighting guides 54 and 56, the carrier portion 70 is formed of anon-attenuating material, such as Lexan® or Plexiglass®. The carrierportion 70 carries a radioactive sighting line 72, which can comprise acapillary tube filled with a radioactive substance, such as Cobalt-57.The horizontal sighting guide 66 will be moved until its sighting line72 lines up with the center of carcinoma site "C", along the Z-axis, ina manner which will be discussed in greater detail below. By use of thethree moveable sighting guides 54, 56 and 66, the carcinoma site "C" canbe accurately localized in its X, Y and Z coordinates, in real-time.

Referring to FIG. 5, the moveable sighting guide 56 carries a slidableruler means 74, which has a slider portion 76 which slides on thecarrier portion 60 of sighting guide 56, and a ruler portion 78extending therefrom. A ruler portion 78 lies parallel to the carrierportion 60. The slidable ruler means 74 can be moved on the carrierportion 60 to measure the distance from the outside face 80 of thefenestrated paddle 24 closest to the vertical track portion 50, to thecrossing point of the sighting lines 60 and 62, to determine the needle42 penetration needed to reach the center of the carcinoma site "C".

The operation of the apparatus 10 is now described. A woman patient whodesires to have a breast carcinoma screening by the method ofscintimammography will be injected with a compound such asTechnetium-99m Sestamibi. The patient will lie on the table 12 with herbreast to be examined pendulously suspended through one of the twoopenings 18. Referring to FIGS. 3-5, the paddles 24 will be moved sothat the patient's breast is compressed at least slightly to immobilizeit and so that the breast will be flattened against the fenestratedpaddle 24. Thereafter, a scintillation detection device 82, i.e. anAnger scintillation camera, will be placed with its detection screen 84parallel to the plane of the moveable sighting guides 54 and 56. Thesighting guides 54 and 56 will be moved so their sighting lines 62 and64, respectively, line up in the "X" and "Y" positions with the centerportion of any carcinoma site "C" detected. The scintillation detectiondevice 80 will then be moved so that its screen 84 is parallel with theplane of the lower surface of the table portion 12, and parallel to thehorizontal sighting guide 66. As shown in FIG. 4, the radioactivesighting line 62 will be aligned with the center of the carcinoma site"C", thereby determining its position in the "Z" axis. By the use of thethree sighting guides 54, 56, and 66, the X, Y, and Z coordinates of thecarcinoma site "C" will be quickly and accurately determined. Once thesighting guides are positioned, the physician will know which hole 30 inthe grid of holes in the fenestrated paddle 24 to insert the needleguide 34 and needle 42. The ruler means 74 will give the physicianaccurate feedback as to how deep to insert the needle 42, to that itstip can be positioned where desired in the carcinoma site "C". For,enhanced function, needles 42 having a radioactive tip (not shown) canbe utilized to confirm the accurate positively of the needle 42 inreal-time 42. Again, the radioactive isotope Cobalt-57 functions well,but other radioactive materials can be utilized. The apparatus 10 canthus be used to accurately localize carcinoma sites in real-time withoutgreatly compressing the patient's breast.

EXAMPLE

The accuracy of the above-referenced apparatus 10 and system inlocalizing carcinoma sites was tested in vitro as described below.

A semi-square sponge breast phantom was placed between the fenestratedpaddles 24, and was compressed in the cranial and caudal directions bythe fenestrated paddles 24. To create a radioactive background similarto the radioactivity in normal breast tissue, a thin sponge wasmoistened with a dilute solution of Technetium-99m, sealed in a plasticbag, and attached it to the surface of the scintillation detector. Alarge synthetic sponge with no radioactivity added was used to representthe breast. A small piece was carved out of the interior of the spongeat a depth of 2˜6.7 cm, labeled with a small amount of radioactivity,and reinserted in the sponge to represent a nonpalapable tumor. The"tumors" ranged from 3 mm to 15 mm in size. Thallium-201 was used tolabel the tumors because the energy of its emissions differs enough fromthose of technetium to allow separate images of each energy, as well asa combined image of the two. In actual practice, Technetium-99mSestamibi alone will be used. The sponge breast phantom containing thelesion was placed between two fenestrated paddles 24 and held in placewith mild compression by the paddles 24. The scintillation detector waspositioned near the phantom and real-time images were acquired in twoorthogonal planes. The sliding guides 54, 56 and 66 were moved so thattheir radioactive sighting lines 62, 64 and 72, respectively, projectedonto the scintillation detector screen 84, intersecting with thedetected position of the "tumor".

Moveable sighting guides 54, 56 and 66 utilizing Technetium-99mSestamibi in lieu of Cobalt-57 in its capillary tubes were used tolocate the X, Y, and Z coordinates of the carcinoma site.

A needle guide 34 was placed in the hole corresponding to the X and Ycoordinates of the "tumor" to allow the needle 42 to be insertedperpendicular to the breast compression portion 28. When the needle tipwas advanced to the correct depth of the "tumor", Technetium-99m wasinjected through the needle 42 into the sponge breast phantom. Pre andpost localization attempt regions of interest (ROI) were defined, andalso, the residual activity in the phantom was measured.

To determine the success of the injection, the "tumor" was carefullyremoved from the phantom, and an image of the empty phantom wasacquired. If the radioactive solution was injected within the tumor, thephantom would not contain radioactivity. If the lesion was "missed," theradioactivity remained in the phantom and appeared on the image. Partial"misses" contain an intermediate amount of the radioactivity in theinjection. The amount of total radioactivity injected and the amountsremaining in the phantom were quantified to give the results representedin FIG. 6.

The results of 30 consecutive localization attempts include: 25 exactlocalizations with more than 80% of tracer injected inside the "lesion",2 near misses with 63 to 56%, and 3 missed locations with 40, 15, and 0%of tracer injected inside the lesion. The missed localizations were allin lesions at least 4 cm deep, and all had partially superimposed ROIswhich indicates the needle came very close to the lesion. Thescintigraphy guide stereotaxic localization system of breast phantomlesions successfully localized 90% of all lesions. Similar results couldbe expected from in vivo practice.

The drawings and the foregoing description are not intended to representthe only form of the invention in regard to the details of thisconstruction and manner of operation. In fact, it will be evident to oneskilled in the art that modifications and variations may be made withoutdeparting from the spirit and scope of the invention. Although specificterms have been employed, they are intended in a generic and descriptivesense only and not for the purpose of limitation, the scope of theinvention being delineated in the following claims:

We claim:
 1. A scintigraphy guided system for stereotaxic localizationof a breast carcinoma, adapted for use in conjunction with ascintillation detection device, of a patient who has been injected witha radioactive substance which preferentially accumulates in carcinoma,said system comprising:a table means, with a top and bottom surface,upon which the patient lies in a prone position, said table means havingat least one opening through which the patient's breast being examinedwill pendulously protrude therethrough; a pair of fenestrated paddlespositioned under the bottom surface of the table means in a vicinity ofsaid at least one opening, said pair of fenestrated paddles beingmoveable relative to each other to compress the patient's breasttherebetween; and a guide means positioned under the table means in thevicinity of the opening, said guide means having a plurality of moveablesighting guides, each moveable along one of three orthogonal axes, eachsighting guide having a radioactive sighting line located thereon,wherein said moveable sighting guides will be moved to line up with thecarcinoma in the breast, as detected by the scintillation detectordevice, to localize the carcinoma in three dimensions and in real-timein the breast.
 2. The scintigraphy guided system for stereotaxiclocalization of breast carcinomas of claim 1, wherein said guide meanscomprises track portions oriented along three orthogonal axes, andwherein said moveable sighting guides comprise track engagement sliderswhich are moveable on said track portions, said moveable sighting guideshaving elongate and non-attenuating carrier portions which extend fromsaid track engagement sliders, and wherein said radioactive sightinglines are carried on said carrier portions.
 3. The scintigraphy guidedsystem for stereotaxic localization of breast carcinomas of claim 2,wherein the radioactive sighting lines comprise capillary tubes filledwith Cobalt-57.
 4. The scintigraphy guided system for stereotaxiclocalization of breast carcinomas of claim 2, wherein the radioactivesighting lines comprise wires containing Cobalt-57.
 5. The scintigraphyguided system for stereotaxic localization of breast carcinomas of claim2, wherein the fenestrated paddles comprise a planar breast compressionportion with a plurality of holes arranged therethrough in a spacedapart pattern, and a slider portion which extends perpendicularly fromsaid planar breast compression portion, and wherein the system furtherincludes slider guides positioned on the bottom surface of the tablemeans wherein said slider portion slides in said slider guides, and saidslider guides further include a locking means for selectablyimmobilizing said fenestrated paddles.
 6. The scintigraphy guided systemstereotaxic localization of breast carcinomas of claim 5, furthercomprising an elongate ruler slidable on the carrier portions of one ofthe moveable sighting guides which is used to determine a distance fromthe breast carcinoma to the planar breast compression portion, so thatan individual using the scintigraphy guided system of the invention candetermine how far to insert a guide needle into a patient's breast toplace a tip of the guide needle into the site of the suspectedcarcinoma.
 7. The scintigraphy guided system for stereotaxiclocalization of breast carcinomas of claim 1, wherein the fenestratedpaddles comprise a planar breast compression portion with a plurality ofholes arranged therethrough in a spaced apart pattern, and a sliderportion which extends perpendicularly from said planar breastcompression portion, and wherein the system further includes sliderguides positioned on the bottom surface of the table means wherein saidslider portion slides in said slider guides, and said slider guidesfurther include a locking means for selectably immobilizing fenestratedpaddles.
 8. The scintigraphy guided system for stereotaxic localizationof breast carcinomas of claim 7, wherein the fenestrated paddles areformed of plastic material.
 9. The scintigraphy guided system forstereotaxic localization of breast carcinomas of claim 7, furthercomprising a biopsy needle guide which fits into any one of theplurality of holes formed in the fenestrated paddles, and ensures that abiopsy needle which is inserted through the biopsy needle guide willpenetrate the breast at generally right angles to the breast compressionplanar portion.
 10. The scintigraphy guided system for stereotaxiclocalization of breast carcinomas of claim 7, wherein the locking meanscomprises a thumbscrew screwable in said slider guides to selectableimmobilize said slider portion located in said slider guides and saidbreast compression portion.
 11. The scintigraphy guided system forstereotaxic localization of breast carcinomas of claim 1, wherein thetable means is generally horizontal, and has an elongate shape, whereinthe at least one opening comprises two openings formed on opposite sideregions of the table means.
 12. A scintigraphy guided system forstereotaxic localization of a breast carcinoma, adapted for use inconjunction with a scintillation detection device, of a patient who hasbeen injected with a radioactive substance which preferentiallyaccumulates in carcinoma, said system comprising:a table means, with atop and bottom surface, upon which the patient lies in a prone position,and at least one opening formed through said table means through whichthe patient's breast being examined will pendulously protrudetherethrough; a pair of fenestrated paddles formed of non-attenuatingmaterial and positioned under the bottom surface of the table means in avicinity of the at least one opening, said pair of fenestrated paddlesbeing moveable relative to each other to compress the patient's breasttherebetween; and a guide means positioned under the table means in thevicinity of the opening, said guide means having a plurality of moveablesighting guides, each moveable along one of three orthogonal axes, eachsighting guide having a radioactive sighting line located thereon;wherein in the use of the system, the patient's breast will becompressed by the fenestrated paddles, and a scintillation detectiondevice will be placed adjacent and generally parallel to a first planedefined by two of said three orthogonal axes along which two sightingguides are moveable, to detect radioactive photons given off by theradioactive substance which has accumulated in said carcinoma, andwherein two sighting guides will be moved so their sighting linesproject over the center of the carcinoma, thus localizing the carcinomain two-dimensions, and the scintillation detection device will be placedparallel to a second plane, orthogonal to said first plane, and in frontof a remaining third sighting guide, and the third sighting guide willbe moved along the third orthogonal axis, until its sighting line is inline with the center of the carcinoma, whereby the three sighting linesof the three sighting guides will thus localize the carcinoma inreal-time and in three-dimensions relative to the fenestrated paddles.13. A scintigraphy guided system for stereotaxic localization of abreast carcinoma, adapted for use in conjunction with a scintillationdetection device, of a patient who has been injected with a radioactivesubstance which preferentially accumulates in the carcinoma, said systemcomprising:a table means, with a top and bottom surface, upon which thepatient lies in a prone position, said table means having at least oneopening through which the patient's breast being examined willpendulously protrude therethrough; a pair of paddles positioned undersaid bottom surface of said table means in the vicinity of said at leastone opening, said pair of paddles being moveable relative to each otherto slightly compress and thereby stabilize the patient's breasttherebetween; and a guide means positioned under said table means in avicinity of said opening and said paddles, said guide means having aplurality of moveable sighting guides, each moveable along one of threeorthogonal axes, each sighting guide carrying a radioactive sightingline, wherein said moveable sighting guides will be moved to line upeach radioactive sighting line with the carcinoma site in the breast, asdetected by the scintillation detector device, to localize the carcinomain three dimensions and in real-time in the breast.
 14. The scintigraphyguided system for stereotaxic localization of breast carcinomas of claim13, wherein the fenestrated paddles comprise a planar breast compressionportion with a plurality of holes arranged therethrough in a spacedapart pattern, and a slider portion which extends perpendicularly fromsaid planar breast compression portion, and wherein the system furtherincludes slider guides positioned on the bottom surface of the tablemeans wherein said slider portion slides in said slider guides, and saidslider guides further include a locking means for selectablyimmobilizing said fenestrated paddles.
 15. The scintigraphy guidedsystem for stereotaxic localization of breast carcinomas of claim 14,wherein said guide means comprise track portions oriented along threeorthogonal axes, and wherein said moveable sighting guides comprisetrack engagement sliders which are moveable on said track portions, saidmoveable sighting guides having elongate and non-attenuating carrierportions which extend from said track engagement sliders, and whereinsaid radioactive sighting lines are carried on said carrier portions.16. The scintigraphy guided system for stereotaxic localization ofbreast carcinomas of claim 14, further comprising an elongate rulerslidable on the carrier portions of one of the moveable sighting guides,and which is used to determine a distance from the breast carcinoma tothe planar breast compression portion, so that an individual using thescintigraphy guided system of the invention can determine how far toinsert a guide needle into a patient's breast to place a tip of theguide needle into a site of a carcinoma.
 17. The scintigraphy guidedsystem for stereotaxic localization of breast carcinomas of claim 13,wherein the radioactive sighting lines comprise wires containingCobalt-57.
 18. The scintigraphy guided system for stereotaxiclocalization of breast carcinomas of claim 13, wherein said pair ofpaddles are formed of a radioactive non-attenuating plastic material.19. The scintigraphy guided system for stereotaxic localization ofbreast carcinomas of claim 13, wherein said table means is generallyhorizontal and has opposite side regions, and said at least one openingcomprises two openings formed on the opposite side regions of the tablemeans.
 20. A scintigraphy guided system for stereotaxic localization ofbreast carcinomas of a patient who has been injected with a radioactivesubstance which preferentially accumulates in carcinomas, adapted foruse in conjunction with a scintillation detection device, said systemcomprising:a table means, with a top and bottom surface, upon which topsurface the patient lies in a prone position, said table means having atleast one opening through which the patient's breast being examined willpendulously protrude therethrough; breast compression and stabilizingmeans located under said bottom surface of said table in a vicinity ofsaid at least one opening which is adapted to stabilize the patient'sbreast pendulously protruding through said at least one opening; and aguide means positioned under said table means in the vicinity of saidopening and said breast compression and stabilizing means, said guidemeans having a plurality of moveable sighting guides, each moveablealong one of three orthogonal axes, each sighting guide carrying aradioactive sighting line, wherein said moveable sighting guides aremovable so each radioactive sighting line will line up with a carcinomain the breast, as detected by the scintillation detector device, tolocalize the carcinoma in three dimensions and in real-time in thebreast.
 21. A method for stereotaxic localization of breast carcinomasof a patient who has been administered a radioactive substance whichgive off radiation and which preferentially accumulates in breastcarcinomas, said method system comprising the following steps:(a)providing a table means having a top and bottom surface with at leastone opening formed therethrough; (b) lying a patient in a prone positionon the top surface of the table means such that the patient's breast tobe examined will pendulously protrude therethrough; (c) administering aradioactive substance which preferentially accumulates in breastcarcinomas of the patient; (d) lightly compressing the patient's breastbeing examined with a pair of paddles positioned on the bottom surfaceof the table means in order to generally immobilize the patient's breastbeing examined; (e) providing a guide means on the bottom surface ofsaid table means in a vicinity of said opening and said pair of paddles,said guide means having a plurality of moveable sighting guides whereinsaid plurality of sighting guides includes at least three sightingguides, each moveable along one of three orthogonal axes, each sightingguide carrying a radioactive sighting line; (f) providing ascintillation detection device with a detector; (g) orienting thedetector such that it is placed adjacent the breast being examined andgenerally parallel to two of the three orthogonal sighting guides in afirst plane such that the two sighting guides are situated between thedetector and the breast so, radiation given off by the two sightingguide' sighting lines and the carcinoma are detected by thescintillation detection device; (h) moving said two moveable sightingguides until their radioactive sighting lines line up with a carcinomasite in the breast, as detected by the scintillation detector device, intwo-dimensions and in real time; (i) orienting the detector such that itis placed generally perpendicular to the first plane, such that thethird sighting guide is situated between the detector and the breast soradiation given off by the third sighting guide's sighting line and thecarcinoma are detected by the scintillation detector; and (j) movingsaid third sighting guide until its radioactive sighting line lines upwith the carcinoma site in the breast, as detected by the scintillationdetector device, thereby locating the carcinoma site in three dimensionsand in real time.
 22. The method of claim 21 wherein the substance whichpreferentially accumulates in carcinomas comprises Technetium-99mSestamibi.